Predictors Of Iron Deficiency Anemia Research Articles

Prevalence and Predictors of Iron Deficiency Anemia among Children in Saudi Arabia

Introduction: The long-term impact of iron deficiency anemia on female children was significantly reducing physical growth, neurological development and learning performance. There is limited data about the magnitude of iron deficiency anemia in Saudi Arabia in young children. This study aimed to assess the prevalence and determinants of iron deficiency anemia in children attending primary health care at the age of the school entry. Methods: This is a cross-sectional study including children at the age of school entry and they should be tested for detection of anemia after their parents sign an informed consent. Children with other types of anemia were excluded from this study. The minimal sample size is calculated using Raosoft calculator based on the equation for proportion estimation. Based on this proportion, at the confidence level of 95% and estimation error of 0.05 the initial sample size is calculated to be 384 participants. A questionnaire was used to collect data from the mothers or caregiver for the children. Results: A total sample of 384 attendants in PHC centers responded to the questionnaire, of them 59.5% were males. About 68% of the mothers have a high level of education as university or postgraduate studies and 83% were married. The prevalence of anemia was found to be 24% among children for both genders. Only nationality was a significant predictor for iron-deficiency anemia among children. Saudis children had a significantly lower prevalence of anemia than non-Saudis. Conclusions: The prevalence of anemia among children at age of school entry was high and more attention to the nutritional habits of children should be given by mothers and health specialists. Educational campaign should be conducted to increase awareness about proper children nutrition among women, particularly women with non-Saudi nationality.

Reticulocyte Hemoglobin Equivalent as an Early Predictor of Iron Deficiency Anemia in Cancer Patients

Reticulocyte Hemoglobin Equivalent as an Early Predictor of Iron Deficiency Anemia in Cancer Patients

Prevalence and predictors of iron deficiency anemia among pregnant women in Bolosso Bomibe district, Wolaita Zone, Southern Ethiopia Community-based cross-sectional study

: Iron-deficiency anemia is defined as anemia, a condition in which there less than the normal hemoglobin (Hb) accompanied by an indication of iron deficiency. Nearly half of all pregnant women worldwide suffer from anemia, and iron deficiency accounts for about half the world’s anemia burden. Most of the studies conducted on iron-deficiency anemia during pregnancy were conducted at the institution level and associated factors are not well studied and documented. Hence, the aim of this study is to determine the prevalence of iron-deficiency anemia and associated factors among pregnant women in Bolosso Bomibe District, Southern Ethiopia, 2019. Community-based cross-sectional quantitative study was conducted from April to June 2019. Multistage sampling was used to include 270 study participants in 6 kebeles. The structured and pretested questionnaire, middle upper arm circumference (MUAC), Hb, serum ferritin, and C-reactive protein were used as a tool to collect data. The data was compiled and entered to EpiData version 3.1 and exported to Statistical Package for Social Sciences (SPSS) version 23.00 packages for analysis. Univariate, bivariate, and multivariable logistic regression with odds ratio along with the 95% confidence intervals (CI) was computed and interpreted. p value < 0.05 was declared as statistically significant. The prevalence of iron-deficiency anemia was 11.3% (95% CI: 8.9–15.7). Factors associated with iron-deficiency anemia were ANC follow-up for the recent pregnancy (adjusted odds ratio [AOR] = 3, 95% CI: 1.15−8.9, and years b/n successive pregnancy (AOR = 4,95% CI: 1.2–12.4). Prevalence of iron-deficiency anemia was low, which is a mild public health concern among pregnant women in Bolosso Bombe District. The factors associated with iron-deficiency anemia in this study population were MUAC, ANC follow-up, birth spacing among successive pregnancy, and duration of menstrual bleeding. Thus, there should be the integration of concerned stakeholders for implementation of different interventions to solve these problems.

285P Reticulocyte hemoglobin equivalent as an early predictor of iron deficiency anemia in cancer patients

Reticulocyte hemoglobin equivalent (RET-He) measures the amount of hemoglobin in the reticulocytes and indicates red cell hemoglobinization, reflecting the quality of the newly produced reticulocytes. It is a useful parameter which allows the diagnosis of IDA before it manifests clinically in a patient and also for treatment follow-up. Therefore, the ability to assess iron deficiency, as part of automated CBC/reticulocyte analysis, may significantly enhance patient management. Etiology of CRA is multifactorial, and is due to myelosuppression secondary to chemotherapy, bone marrow failure, chronic inflammation, and/or iron deficiency.

Predictors of iron consumption for at least 90\u2009days during pregnancy: Findings from National Demographic Health Survey, Pakistan (2017\u20132018)

BackgroundIron supplementation is considered an imperative strategy for anemia prevention and control during pregnancy in Pakistan. Although there is some evidence on the predictors of iron deficiency anemia among Pakistani women, there is a very limited understanding of factors associated with iron consumption among Pakistani pregnant women. Thus, this study aimed to investigate the predictors of iron consumption for at least ≥90 days during pregnancy in Pakistan.MethodsWe analyzed dataset from the nationally representative Pakistan Demographic Health Survey 2017–2018. The primary outcome of the current study was the consumption of iron supplementation for ≥90 days during the pregnancy of the last birth. Women who had last childbirth 5 years before the survey and who responded to the question of iron intake were included in the final analysis (n = 6370). We analyzed the data that accounted for complex sampling design by including clusters, strata, and sampling weights.ResultsAround 30% of the women reported consumed iron tablets for ≥90 days during their last pregnancy. In the multivariable logistic regression analysis, we found that factors such as women’s age (≥ 25 years) (adjusted prevalence ratio (aPR) = 1.52; 95% CI: 1.42–1.62)], wealth index (rich/richest) (aPR = 1.25; [95% CI: 1.18–1.33]), primary education (aPR = 1.33; [95% CI: 1.24–1.43), secondary education (aPR = 1.34; [95% CI: 1.26–1.43), higher education (aPR = 2.13; [95% CI: 1.97–2.30), women’s say in choosing husband (aPR = 1.68; [95% CI: 1.57–1.80]), ≥ five antenatal care visits (aPR =2.65; [95% CI (2.43–2.89]), history of the last Caesarian-section (aPR = 1.29; [95% CI: 1.23–1.36]) were significantly associated with iron consumption for ≥90 days.ConclusionThese findings demonstrate complex predictors of iron consumption during pregnancy in Pakistan. There is a need to increase the number of ANC visits and the government should take necessary steps to improve access to iron supplements by targeting disadvantaged and vulnerable women who are younger, less educated, poor, and living in rural areas.

Clinical Predictors of Iron Deficiency Anemia in Emirati Population with T2DM

Aim: To establish the prevalence of iron deficiency anemia and its clinical predictors in Emirati patients with type 2 diabetes. Patients & Methods: 237 patients were included in the study. A full blood count was obtained in addition to routine blood and urine tests for all patients. Hemoglobin level and iron studies were done for diagnosis of anemia. Statistical analysis was done to find out the prevalence and independent predictors of anemia in the study population of Emirati type 2 diabetic patients. Results: Of the studied 237 patients; 36.3% had iron deficiency anemia as per the WHO criteria. Independent predictors of iron deficiency anemia were age ≥ 60 years, female gender and wide pulse pressure ≥ 60 mmHg. Hemoglobin level was directly proportionate to e GFR (p < 0.001). Participants with age ≥ 60 years had 4.2 times higher odds to exhibit anemia. Female participants had 1.95 times higher odds to exhibit anemia. Participants with wide pulse pressure ≥ 60 mmHg have 2.4 higher odds to exhibit anemia. Conclusion: Iron deficiency anemia is common in type 2 diabetic patients. Testing the patient for iron deficiency anemia should be considered in type 2 diabetes patients especially with age ≥ 60 years, female patients and those with wide pulse pressure ≥ 60 mmHg.

Predictors of iron-deficiency anemia in primary care older adults: a real-world European multi-country longitudinal study.

Iron deficiency is a major cause of anemia in older people. Increasing the knowledge on the predictors of iron-deficiency anemia (IDA) may facilitate its timely diagnosis. To investigate the predictors of IDA in older people in four European countries. Retrospective longitudinal study. Primary care patients aged 65 or older (N = 24,051) in four European countries. IDA predictors were estimated using multivariate Cox regression based on information gathered from national primary care databases: Italy (years 2002-2013), Belgium, Germany and Spain (years 2007-2012). Adjusted hazard ratios (aHR) with 95% confidence intervals (CIs) were estimated. In Spain and Belgium, men were at greater risk of IDA than women, while they had a lower risk in Italy. Weakness, irritability, alopecia and xerostomia were signs and symptoms significantly associated with IDA. Concurrent diseases, potential causes of anemia, positively associated with IDA were small bowel polyposis, stomach cancer, obesity, gastritis and peptic ulcer, esophagitis, Crohn's disease, celiac disease, lymphangiectasis, gastrectomy or gastric atrophy, gut resection or bypass, and cardiac prosthetic valve. Aspirin users had a 12-35% higher hazard of IDA than non-users. Similarly, corticosteroids and anti-acids were positively associated with IDA. A higher level of comorbidity was associated with an increased hazard of IDA in all countries. Specific signs and symptoms, chronic conditions, a greater comorbidity burden, and specific pharmacological treatments registered in primary care databases represent relevant predictors and correlates of incident IDA in older people in Europe. General practitioners might employ this information to obtain early diagnosis of IDA in community-dwelling older adults.

Prevalence and predictors of iron-deficiency anemia: Women's health perspective at reproductive age in the suburb of dried Urmia Lake, Northwest of Iran.

BACKGROUND:Dried Urmia Lake in the northwest of Iran is a major regional source of sodium and toxic metal aerosols which may cause numerous health problems. The aim of this study was to evaluate iron-deficiency anemia (IDA) and some related risk factors among women of reproductive age in the suburb of dried Urmia Lake to provide the information about the problem to the health-care providers.METHODS:This cross-sectional study was conducted on 278 healthy nonpregnant, nonlactating women aged 18–45 years, living in the rural area of the Salmas city, closest to the Urmia Lake between February and June 2017. The study participants were selected using a stratified random sampling method with proportional allocation from seven villages. A general questionnaire was completed for each participant to collect sociodemographic information and a 3-day dietary recall questionnaire to obtain daily dietary intakes. IDA was defined as a hemoglobin (Hb) level of <12 g/dl and ferritin concentration of <15 μg/l. Spearman's correlation coefficient and Fisher's exact test were applied to determine sociodemographic factors associated with the serum Hb and ferritin levels.RESULTS:The prevalence of overall anemia (Hb <12 g/dl) was 7.9%. IDA was determined in 4.3% and iron deficiency (ID) in 19.1% (serum ferritin <15 μg/l) of the participants. There was a significant positive correlation between serum Hb concentrations and the mean daily intakes of protein and iron (P < 0.001). Similarly, a significant positive correlation was observed between serum ferritin levels and body mass index (P < 0.001). Significant inverse associations were found between Hb concentrations and the number of pregnancies and children (P < 0.001), as well as the number of family members (P < 0.05).CONCLUSIONS:Results indicated a mild prevalence of IDA and a relatively high rate of ID among studied participants. Educational programs are needed to improve nutritional habits as well as the use of contraceptives to promote women's health.

TEA CONSUMPTION AND IRON-DEFICIENCY ANEMIA AMONG PREGNANT WOMAN IN BOGOR DISTRICT, INDONESIA

Background. Anemia in pregnancy is an essential problem due to affect to not only the mother’s life but also to baby’s life. An iron deficiency causes about 75 percent of anemia during pregnancy. Objective. This study aimed to identify risk factors for iron deficiency among pregnant women and determine the possible link between iron status and tannin levels associated with tea consumption. Method. The population-based cross-sectional studies were conducted from secondary data of previous thesis-research in 2013, “Pengaruh Kadar Tanin pada Teh Celup terhadap Anemia Gizi Besi (AGB) pada Ibu Hamil di UPT Puskesmas Citeureup Kabupaten Bogor Tahun 2012”. The study population consisted of 94 randomly selected pregnant women. The inclusion criteria were pregnant women who participated in the previous study and have a complete antenatal care record. Demographic data were collected, including data on age, working status, gestational stage, time since last pregnancy, and parity. The information included nutritional variables, such as iron supplements, nutritional status, and iron intake. Also, data for tannin level grouped as low, medium, and high based on the frequency of daily tea consumption and tea-making habits. The linear model analysis was used to determine the influence of tea consumption on serum ferritin levels. Results. The results showed that time since last pregnancy (&lt;2 years), parity (more than two children), reduced consumption of foods containing heme, and levels of tannin consumption (low, medium, or high) were predictors of iron-deficiency anemia. The results also suggested that tannin levels were inversely proportional to serum ferritin levels. Conclusion. Pregnant women who consumed tea with a low tannin level had the highest serum ferritin levels, whereas those who drank tea with medium and high tannin levels had the lowest serum ferritin levels.

The Prevalence and Predictors of Iron Deficiency Anemia among Rural Infants in Nablus Governorate.

Iron deficiency anemia (IDA) in infants and young children remains a significant public health problem in most developing countries. IDA had short and long-term adverse impacts on infants' health and development. We aimed to assess the frequency of IDA and associated risk factors among infants aged between 9-12 months in rural areas of Nablus Governorate. A cross-sectional study. The study was conducted between Jan and Mar 2015. A random sample of 654 infants aged 9-12 months were selected from thirty villages in Nablus Governorate, Central Highlands of the West Bank, north of Jerusalem. Data were collected using pre-designed structured interviewing questionnaire, complete blood count analysis and anthropometric measurements were done. The prevalence of anemia and IDA among infants was 34.6%, and 32.6%, respectively. Predictors of IDA were increased in infants' age OR=1.19 (95% CI: 1.02, 1.40), maternal anemia during the third trimester OR=2.39 (95% CI: 1.55, 3.71), birth spacing less than three years OR=2.86 (95%CI: 1.58, 5.18), exclusive breastfeeding during the first six months OR=2.40 (95% CI: 1.46, 3.95), early OR=1.64 (95%CI: 1.03, 2.613) and late introduction of complementary feeding OR=2.26 (95% CI: 1.27, 4.05), and non-compliance to iron supplement in the correct frequency and duration during pregnancy OR=1.81 (95% CI: 1.19, 2.75). Different dietary and non-dietary risk factors for IDA should be considered for any intervention aimed to reduce the prevalence of IDA among infants.

Prevalence and determinants of iron deficiency anemia among non-pregnant women of reproductive age in Pakistan.

Iron deficiency Anemia (IDA) in women of reproductive age is a recognized public health concern that impairs health and well-being in women and is associated with adverse reproductive outcomes. In Pakistan there is a dearth of up-to-date information on the prevalence and predictors of IDA. This study sought to investigate IDA in Pakistani women. Secondary analysis was performed using the National Nutrition Survey in Pakistan 2011- 2012. We used a pre-structured instrument to collect socio demographic, reproductive and nutritional data on women. We also collected anthropometric measurements and blood samples for micronutrient deficiencies. Univariate and multivariate logistic regression were used to analyse the data. A total of 7491 non-pregnant women aged between 15-49 years were included in the analysis. The prevalence of IDA was 18.1%. In the multivariate regression analysis; not using iron folic acid supplementation during the last pregnancy adjusted odds ratio (AOR) (95% CI) 1.31 (1.05, 1.64), a history of four or more pregnancies AOR (95% CI) 1.30 (1.04, 1.60), birth interval of <24 months AOR (95% CI) 1.27 (1.06, 1.71), household food insecurity AOR (95% CI) 1.42 (1.23, 1.63) and presence of clinical anemia AOR (95% CI) 5.82 (4.82, 7.02) were significantly associated with increased odds of IDA while with obesity AOR (95% CI) 0.60 (0.4, 0.88) showed a protective effect on IDA. To reduce IDA in Pakistani women, the country needs a multifaceted approach that incorporates iron supplementation, food fortification, improved family planning services and efforts to reduce food insecurity.

Prevalence of anemia and associated factors in women of childbearing age in rural Lebanon

This community-based, cross-sectional survey was conducted to determine the prevalence of anemia and iron deficiency anemia (IDA) and their association with nutritional behavior and other determinants. Arabic-speaking women, aged 15–49 years old, residing in Lebanon’s rural areas were included. Demographic and behavioral characteristics, obstetrical and gynecological history, personal and family medical history, and dietary intake data were collected. Predictors of anemia and IDA were determined using logistic regression. A total of 578 women were included (Lebanese: 55.2%; Syrian: 43.3%) in which 35.5% had anemia and 23.2% had IDA. The mean number of pregnancies was 3.1 ± 3.0 (number of children: 2.5 ± 2.5). In total, 30% had a personal history of anemia or IDA, 29% a family history of anemia, and 20% a family history of IDA. Iron-rich products were consumed by > 90% of the women, whereby > 66.7% mentioned eating liver, tuna, dates and nuts. Syrian nationality (OR = 2.21; CI 95%: 1.38–3.54), age (OR = 1.03, CI 95%: 1.00–1.06), personal history of anemia (OR = 1.97; CI 95%: 1.31–2.95), consumption of dates (OR = 2.07, CI 95%: 1.29–3.31), molasses (OR = 1.61; CI 95%: 1.03–2.51), and soft drinks > 5 times/week (OR = 1.66; CI 95%: 1.09–2.53) were predictors of anemia. Syrian nationality (OR = 1.73, CI 95%: 1.14–2.62), number of pregnancies (OR = 1.08; CI 95%: 1.01–1.15), period > 8 days (OR = 2.01, CI 95%: 1.07–3.80), consumption of eggs (OR = 0.48; CI 95%: 0.25–0.90), dates (OR = 2.58, CI 95%: 1.49–4.46), and coffee or tea (OR = 1.59, CI 95%: 1.03–2.45) were predictors of IDA. Anemia and IDA are prevalent in women of childbearing age in rural Lebanon. Intervention programs for raising the population’s awareness about IDA’s risk factors and proper nutrition must be implemented.

Prevalence and Predictors of Iron Deficiency Anemia in Children under Five Years of Age in Pakistan, A Secondary Analysis of National Nutrition Survey Data 2011-2012.

BackgroundIron deficiency Anemia (IDA) in children is a recognized public health problem that impacts adversely on child morbidity, mortality and impairs cognitive development. In Pakistan information on the true prevalence and predictors of IDA is limited. This study sought to investigate IDA in children under five years of age using data from a nationally representative stratified cross-sectional survey.MethodsSecondary analysis was performed on the National Nutrition Survey in Pakistan 2011–2012. We used a pre-structured instrument to collect socio demographic and nutritional data on mothers and children. We also collected Anthropometric measurements and blood samples for micronutrient deficiencies. IDA was defined as having both haemoglobin levels of <110 g/L and ferritin levels of < 12 μg/L. Data analysis was performed by applying univariate and multivariate techniques using logistic regression through SPSS.FindingsA total of 7138 children aged between 6–59 months were included in the analysis. The prevalence of IDA was 33.2%. In multivariate regression analysis adjusted odds ratios (AOR) were calculated. Age < 24 months (AOR 1.40, 95% CI 1.18–1.55 p <0.05), stunting (AOR 1.42 CI 1.23–1.63 p<0.05), presence of clinical anemia (AOR 5.69 CI 4.93–6.56 p<0.05), having a mother with IDA (AOR 1.72 CI 1.47–2.01 p<0.05) and household food insecurity (AOR 1.20 CI 1.10–1.40 P<0.05) were associated with IDA. Living in a rural area (AOR 0.77 CI 0.65–0.90 p<0.05) and being a female child (AOR 0.87 CI 0.76–0.98 p<0.05) were associated with reduced odds of IDA.ConclusionThe prevalence of IDA amongst Pakistani children represents a moderate burden that disproportionately affects the youngest, growth retarded children, affected children are more likely to have mothers with IDA and live in areas where food security is lacking. National efforts to alleviate the burden of IDA should involve both short term vertical programs such as iron supplementation and long term horizontal programs including wheat flour fortification.

Reticulocyte hemoglobin content as a predictor of iron deficiency anemia

Background Iron deficiency anemia (IDA) is the most common form of anemia in developing countries, such as Indonesia. Iron deficiency anemia in children is a serious problem because it affects their growth and development. Early detection of IDA and subsequent treatment in childhood may prevent future health problems.Objective To assess the use of reticulocyte hemoglobin content (CHr) to detect IDA in children aged 6-60 months.Methods We performed a cross-sectional study to measure the sensitivity and specificity of CHr compared to serum ferritin which is considered to be the gold standard for IDA diagnosis. The study was conducted from September 2011 to March 2013 in children aged 6-60 months who visited the Pediatric Outpatient Clinic, Sanglah Hospital, and Puskesmas II in West Denpasar. Data analysis was performed by 2x2 table. The results were assessed by area under the curve (AUC) and receiver operating characteristic (ROC).Results Of 121 children underwent blood testing during the study period, 69 children were excluded because they did not have hypochromic microcytic anemia, leaving 52 subjects eligible for the study. The prevalence of IDA in this study was 31%. Reticulocyte hemoglobin content (CHr) ≤ 23.1 pg had 88% (95%CI 71 to 100%) sensitivity and 25% (95%CI 11 to 39%) specificity.Conclusion Reticulocyte hemoglobin content &lt; 23.1 pg may be a good predictor of IDA.

Reticulocyte hemoglobin content as a predictor of iron deficiency anemia

Reticulocyte hemoglobin content as a predictor of iron deficiency anemia

Nutritional iron deficiency anemia: magnitude and its predictors among school age children, southwest Ethiopia: a community based cross-sectional study.

BackgroundIron deficiency anemia (IDA) is a global public health problem among school age children, which retards psychomotor development and impairs cognitive performance. There is limited data on prevalence and risk factors for IDA.ObjectiveThe aim of this study was to determine the prevalence, severity, and predictors of nutritional IDA in school age children in Southwest Ethiopia.MethodologyA community based cross-sectional study was conducted in Jimma Town, Southwest Ethiopia from April to July 2013. A total of 616 school children aged 6 to 12 years were included in the study using multistage sampling technique. A structured questionnaire was used to collect sociodemographic data. Five milliliter venous blood was collected from each child for hematological examinations. Anemia was defined as a hemoglobin level lower than 11.5 g/dl and 12 g/dl for age group of 5–11 years and 12–15 years, respectively. Iron deficiency anemia was defined when serum iron and ferritin levels are below 10 µmol/l and 15 µg/dl, respectively. Moreover, fresh stool specimen was collected for diagnosis of intestinal parasitic infection. Stained thick and thin blood films were examined for detection of Plasmodium infection and study of red blood cell morphology. Dietary patterns of the study subjects were assessed using food frequency questionnaire and anthropometric measurements were done. Data were analyzed using SPSS V-20.0 for windows.ResultOverall, prevalence of anemia was 43.7%, and that of IDA was 37.4%. Not-consuming protein source foods [AOR = 2.30, 95%CI(1.04,5.14)], not-consuming dairy products [AOR = 1.83, 95%CI(1.14,5.14)], not-consuming discretionary calories [AOR = 2.77, 95%CI(1.42,5.40)], low family income [AOR = 6.14, 95%CI(2.90,12.9)] and intestinal parasitic infections [AOR = 1.45, 95%CI(1.23, 5. 27)] were predictors of IDA.ConclusionIron deficiency anemia is a moderate public health problem in the study site. Dietary deficiencies and intestinal parasitic infections were predictors of IDA. Therefore, emphasis should be given to the strategies for the prevention of risk factors for IDA.

Iron deficiency in infancy: applying a physiologic framework for prediction

Infants aged 6-24 mo are at high risk of iron deficiency. Numerous studies worldwide have sought to identify predictors of iron deficiency in this age group. The objectives of the study were to apply a physiologic model to identify risk factors for iron deficiency and to consider those risk factors under different conditions of iron supplementation. We predicted that factors related to iron status at birth (lower gestational age and lower birth weight), postnatal needs for iron (more rapid growth), and bioavailable iron (more cow milk) would be major risk factors. The physiologic framework was assessed in 1657 Chilean infants (aged 12 mo) with birth weights >or=3 kg who were randomly assigned at age 6 mo to high or low iron supplementation or no added iron. Based on venous blood, the analysis used mean corpuscular volume and concentrations of hemoglobin, free erythrocyte protoporphyrin, and ferritin. Logistic regression models were used to identify predictors of iron deficiency anemia and iron deficiency without anemia. The prevalence of iron deficiency (>or=2 abnormal iron measures) was 34.9% at age 12 mo. Of 186 infants with hemoglobin concentrations <110 g/L, 158 (84.9%) were iron deficient. The only consistent (and the strongest) predictor of iron deficiency or iron deficiency anemia was lower 6-mo hemoglobin. Factors related to poorer iron status at birth (lower birth weight, shorter gestation though full-term, or both) were predictors in the no-added-iron and high-iron groups. Otherwise, predictors varied by iron supplementation. Variations in predictors of iron deficiency or iron deficiency anemia according to iron supplementation suggest that direct comparisons across studies are tenuous at best without data on early iron status and certainty that specific conditions are comparable.

Transferrin receptor in tissue and serum: updated clinical significance of soluble receptor.

The transferrin receptor is an essential component of cellular uptake of iron, and it binds to serum transferrin. Recently, 2 different types of transferrin receptors have been recognized: transferrin receptor (TfR or transferrin receptor 1) and transferrin receptor 2. Most cells possess a ubiquitous system controlling the biosynthesis of TfR at the posttranscriptional level to avoid excess iron influx into the cells through TfR. During the process of recycling of transferrin receptors, some are shed and appear as soluble or serum transferrin receptors. Measurement of serum transferrin receptor is a new marker of iron metabolism that reflects body iron stores and total erythropoiesis. It has been shown that serum transferrin receptor to ferritin ratios have significant predictive value for differentiating iron deficiency anemia from non-iron deficiency anemia, such as anemia of chronic disorders, whereas serum ferritin is the only significant independent predictor of iron deficiency anemia.

Current Literature: Reticulocyte Hemoglobin Content to Diagnose Iron Deficiency in Children

Context: Early identification of iron deficiency in children is essential to prevent the damaging long‐term consequences of this disease. However, it is not clear which indices should be included in a diagnostic panel for iron deficiency and iron deficiency anemia in children. Objectiiv: To develop an effective approach for the diagnosis of iron deficiency and iron deficiency anemia in young children. Design and Setting: Retro spective laboratory analysis, carried out over 7 weeks in 1996, using blood samples ordered by pediatricians and sent to a large metropolitan hospital for analysis. Patients: A total of 210 children (mean [SD] age, 2.9 (2.0] years; 120 were male) who had a lead screening test (complete blood cell count and plasma lead level) ordered by a primary care pediatrician. Main Outcome Measures: Levels of hemoglobin (Hb), iron, transferrin, transferrin saturation (Tfsat), ferritin, and circulating transferrin receptor (TfR) and reticulocyte Hb content (CHr) among patients with and without iron deficiency, defined as Tfsat of less than 20%, and iron deficiency anemia, defined as Tfsat of less than 20% and Hb level less than 110 g/L. Results: Of the 210 subjects, 43 (20.5%) were iron deficient; 24 of these had iron deficiency anemia. Reticulocyte Hb content and Hb levels were the only significant predictors of iron deficiency (likelihood ratio test [LRT] = 15.96; P &lt; 0.001 for CHr, and LRT = 6.59; P = 0.01 for Hb), and CHr was the only significant multivariate predictor of iron deficiency anemia (LRT = 30.43; P &lt; 0.001). Plasma ferritin level had no predictive value (P = 0.97). Subjects with CHr of less than 26 pg (optimal cutoff value based on sensitivity/specificity analysis) had lower Hb level, mean corpuscular volume, mean corpuscular Hb level, serum iron level, and Tfsat, and increased red blood cell distribution width vs those with CHr of 26 pg or more (P &lt; 0.001 for all). Conclusions: Reticulocyte Hb content level was the strongest predictor of iron deficiency and iron deficiency anemia in children. It holds promise as an alternative to biochemical iron studies in diagnosis. (JAMA 281:2225–2230, 1999)

Reticulocyte hemoglobin content to diagnose iron deficiency in children.

Early identification of iron deficiency in children is essential to prevent the damaging long-term consequences of this disease. However, it is not clear which indices should be included in a diagnostic panel for iron deficiency and iron deficiency anemia in children. To develop an effective approach for the diagnosis of iron deficiency and iron deficiency anemia in young children. Retrospective laboratory analysis, carried out over 7 weeks in 1996, using blood samples ordered by pediatricians and sent to a large metropolitan hospital for analysis. A total of 210 children (mean [SD] age, 2.9 [2.0] years; 120 were male) who had a lead screening test (complete blood cell count and plasma lead level) ordered by a primary care pediatrician. Levels of hemoglobin (Hb), iron, transferrin, transferrin saturation (Tfsat), ferritin, and circulating transferrin receptor and reticulocyte Hb content (CHr) among patients with and without iron deficiency, defined as Tfsat of less than 20%, and iron deficiency anemia, defined as Tfsat of less than 20% and Hb level of less than 110 g/L. Of the 210 subjects, 43 (20.5%) were iron deficient; 24 of these had iron deficiency anemia. Reticulocyte Hb content and Hb levels were the only significant predictors of iron deficiency (likelihood ratio test [LRT] = 15.96; P<.001 for CHr, and LRT = 6.59; P = .01 for Hb), and CHr was the only significant multivariate predictor of iron deficiency anemia (LRT = 30.43; P<.001). Plasma ferritin level had no predictive value (P = .97). Subjects with CHr of less than 26 pg (optimal cutoff value based on sensitivity/specificity analysis) had lower Hb level, mean corpuscular volume, mean corpuscular Hb level, serum iron level, and Tfsat, and increased red blood cell distribution width vs those with CHr of 26 pg or more (P<.001 for all). Reticulocyte Hb content level was the strongest predictor of iron deficiency and iron deficiency anemia in children. It holds promise as an alternative to biochemical iron studies in diagnosis.